Managed care, ethics, and academic health centers: maximizing potential, minimizing drawbacks

As academic health centers (AHCs) enter into various forms of managed care, they face a number of managed care's well-known ethical issues: utilization controls and loss of clinical autonomy; incentives and conflicts of interest; strained collegial relations; and questionable origin and validity of practice guidelines. Also, special issues arise regarding teaching relationships, faculty structure, and standards of care. Although the ethical hazards of current forms of managed care are quite pervasive and arise largely through short-sighted cost controls, emerging forms of integration and payer-level capitation permit considerably greater flexibility to provide care that is coherent, comprehensive, even creative. AHCs, as integrated multispecialty group practices, may be in a surprisingly good position to explore the best possibilities of global capitation while minimizing the ethical drawbacks of current forms of managed care.